February 28, 2019

A doctoral student discovers the possible benefits and policy lessons of health care reform when it comes to children’s health.

One of the most important goals of the Affordable Care Act (ACA) was to address the broad disparities in access to health care among children from different ethnic and racial backgrounds. When compared to non-Latino white children, for instance, non-Latino black, and Latino children are generally less likely to have a usual source of health care, more likely to delay care, and their parents are more likely to report financial or insurance reasons as barriers.

A new study, “Racial and Ethnic Disparities in Provider-Related Barriers to Health Care for Children in California After the ACA,” published in Global Pediatric Health and led by Cinthya Alberto, MPH, a doctoral student in the department of Health Management and Policy (HMP) at the Dornsife School of Public Health at Drexel University, sought to better understand the association between the implementation of the ACA and the status of disparities in health care access affecting children in post-ACA in California.

“Immigration and health have always been intertwined. Given the current status of immigration reform in the United States and crisis at the US-Mexico border, it is of great importance to understand the role and influence that Congress, state, and local level stakeholders have in addressing health disparities for children regardless of their race or ethnicity,” Alberto says. In addition to the Global Pediatric Health study, I also recently published an article in Human Rights Review along with professor Mariana Chilton, PhD. The work applies a public health framework and provides recommendations for addressing transnational violence against asylum-seeking children at the US-Mexico border.

“The ACA does not explicitly target the health care needs of children, but we have observed some post-ACA improvements in health insurance coverage rates among children,” Alberto says. “Given the contextual factors in California (i.e. early Medicaid expansion and coverage for undocumented children), assessing the post-ACA status of racial and ethnic disparities in provider-related barriers in the state — such as providers not accepting children as new patients or parents having trouble finding providers for their children — was of great interest.” 

Using California Health Survey data on children 11 years old and younger, Alberto and fellow researchers Alex Ortega, PhD, Jessie Kemmick Pintor, PhD, and Ryan McKenna, PhD, also of Dornsife’s HMP department, found that in California’s post-ACA environment there were “no significant racial and ethnic disparities in accessing health care among children. Access to insurance and well-child visits improved across-the-board.”  Yet, the study did find that a noticeable proportion of the parents surveyed continued to report difficulties with certain barriers to accessing care, including a significant disparity in health care access between people with public and private insurance vs. people using insurance plans provided by their employers, especially when seeing appointments at physician offices. 

While the study did not establish the ACA as the direct reason for improved coverage and care among children in California, the study suggests a strong association that can inform policy in other states. “This work may help policy makers discover how to improve health disparities among children of different racial and ethnic groups,” Alberto says. 

While gaps in health care services still exist in California (i.e. undocumented adult populations), the state’s inclusive health policies and programs for children have contributed to what was observed in this study. Alberto adds, “the research provides evidence that having health programs and policies can make a difference in reducing racial and ethnic disparities both at a state level and in community-based physician practices.”

Read the study.